Modern management of anal fistula

Anal fistula closure with FiLaC: new hope or the same old story?

“…The disease spectrum ranges from simple submucosal fistula tracts to an extrasphincteric fistulas involving multiple tracts and, while the treatment of the simplest ones is easy and safe, the more complex fistulas require expert surgeons and often multiple operations.The modern surgical approach to anal fistulas includes several sphincter-saving procedures including the closure of the fistula tract with plugs, fibrin glue, or collagen paste without fistulotomy (i.e., laying open) or by means of fistulectomy (i.e., core-out technique) [1]. However, despite several encouraging reports, though few randomized controlled trials, there is still some skepticism among coloproctologists about the effectiveness of these new sphincter-saving procedures.…”

“…The modern surgical approach to anal fistulas includes several sphincter-saving procedures including the closure of the fistula tract with plugs, fibrin glue, or collagen paste without fistulotomy (i.e., laying open) or by means of fistulectomy (i.e., core-out technique) [1]. However, despite several encouraging reports, though few randomized controlled trials, there is still some skepticism among coloproctologists about the effectiveness of these new sphincter-saving procedures.…”

High Ligation of the Anal Fistula Tract by Lateral Approach

“…For the complex fistula with significant proportion of the anal sphincter involved, the ligation of intersphincteric fistula tract (LIFT) procedure appears to be safe and effective and may be routinely considered for complex anal fistula [2,3]. Ye et al stated that they developed a modified method because of the poor outcomes after performing the classic Thailand LIFT procedures in their institute.…”

Clinical efficacy of anal fistula plug treatment regimens in anal fistula patients

“…Although traditional therapeutic options, such as fistulectomy, thread-drawing therapy, fibrin glue application etc., were used for the management of anal fistula with good healing rates, the clinical efficacy of these operations was not entirely satisfactory primarily due to long healing time, large size wounds and impaired anal function which seriously affect life quality of patients [2,3]. Moreover, high recurrence rate and high incontinence rate followed by the above operations are still enormous challenges, even for experienced anorectal surgeons [4,5]. Currently, according to the latest anal fistula treatment guidelines of American Society of Colon and Rectal Surgeons (ASCRS), it clearly pointed that it was equally important for treated patients in healing anal fistula and maintaining anal function, meanwhile it also must be balanced among the degree of sphincter incision, cure rate and postoperative anal function [6].…”

“…Currently, according to the latest anal fistula treatment guidelines of American Society of Colon and Rectal Surgeons (ASCRS), it clearly pointed that it was equally important for treated patients in healing anal fistula and maintaining anal function, meanwhile it also must be balanced among the degree of sphincter incision, cure rate and postoperative anal function [6]. Therefore, the ideal therapeutic goal for anal fistula should aim to minimize or eradicate the injury to the anal sphincters, promote healing of the tract, preserving the sphincters' function and prevent future recurrence [1,5].…”